Lang Brian Hung-Hin, Wong Carlos K H, Tsang Raymond K Y, Wong Kai Pun, Wong Birgitta Y H
Department of Surgery, Division of Endocrine Surgery, University of Hong Kong, Hong Kong, SAR, China,
Ann Surg Oncol. 2014 Oct;21(11):3548-56. doi: 10.1245/s10434-014-3770-y. Epub 2014 May 28.
Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective.
Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty.
RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely.
In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost.
虽然甲状腺切除术后进行常规喉镜检查（RLE）的花费可能高于选择性喉镜检查（SLE），但它能更早地发现和治疗声带麻痹（VCP），因此从长远来看可能节省成本。我们从机构角度比较了RLE与甲状腺切除术后2周（SLE - 2w）、1个月（SLE - 1m）和3个月（SLE - 3m）进行的SLE的两年成本效益。
我们的病例定义是一名50岁的女性，因良性多结节性甲状腺肿接受择期全甲状腺切除术。构建了一个决策分析模型，以比较2年后RLE、SLE - 2w、SLE - 1m和SLE - 3m之间的估计成本效益。结局概率、效用和成本均从文献中估算得出。成本效益阈值设定为50,000美元/质量调整生命年。采用敏感性和阈值分析来检验模型的不确定性。
RLE不具有成本效益，因为其相对于SLE - 2w、SLE - 1m和SLE - 3m的增量成本效益比分别为每年302,755美元、227,883美元和247,105美元。仅当暂时性VCP发生率增加>42.7%或RLE成本等于零时，RLE才具有成本效益。同样，仅当3个月时暂时性VCP的发音障碍增加>39.13%、3个月时永久性VCP的发音障碍增加>50.29%或3个月时无VCP的发音障碍增加>42.69%时，SLE - 2w相对于SLE - 3m才具有成本效益。然而，这些情况在临床上似乎都不太可能出现。
从机构角度来看，与其他三种SLE策略相比，RLE不具有成本效益。关于SLE的最佳时机，SLE - 3m因其总体成本相对较低，似乎是一种合理且可接受的策略。
